Shot, Stabbed and Assaulted: Violence Against Nurses

Check out this excellent video on workplace violence against nurses by Newsy investigative reporter Patrick Terpstra.

Aside from the jarring videos of nurses being attacked and the tragic interviews as they recount the attacks and try to recover — physically and emotionally — the video is also packed with information:

Over 2400 nurses are victims of workplace violence every year and the number increased 30% since 2012 according to the Bureau of Labor Statistics.

Hospitals consider attacks and threats against health care workers to be “part of the job.”

Part the reason for the increase is that hospitals are faced with more and more psychiatric patients and patients who have substance abuse problems.

Instead of responding to the increase, OSHA has reduced its efforts to address violence in health care. There were only 81 workplace violence-related OSHA inspections last year out of over 32,000 total inspections, down from 131 the year before.

Prior to January 2017, OSHA had an emphasis program that included programmed (or random unannounced) inspections for workplace violence in nursing homes and health care institutions. The elimination of the program explains much of the reduction in workplace violence citations.

Because there is no OSHA standard covering workplace violence, OSHA is forced to use the burdensome General Duty Clause. Because of the difficulty of using the General Duty Clause, the agency often only issues warning letters instead of citations. Terpstra found that one-quarter of inspections from 2012-2017 resulted in warning letters, and fewer than half with citations. Nothing requires inspectors to follow up on hazard letters.

Ten states have some kind of law or OSHA standard covering workplace violence, although it is unclear how effective they are in preventing incidents.

One of the last actions of the Obama administration was to begin rulemaking on a workplace violence standard. The Trump administration has scheduled a small business (SBREFA) review to gather information on the impact of a standard on small businesses. Given the amount of time standards take at OSHA and this administration’s dislike of any new regulations, it is unlikely a final standard will see the light of day in this term.

6 Comments

Instead of just identifying a requirement in a standard that has been violated, you have to show that there was a serious hazard, that it was recognized, and that there is a feasible means of abatement. In practice, you also have to show that workers have already been injured and if the employer has a sort of decent program and has been doing something (even if clearly not enough), no GDC citation. That’s why all the Hazard Alert Letters, despite clear hazards that hadn’t been addressed.

Why wasn’t a standard be done before 2016? This has been a known hazard for many years. I was at the 2016 RFI meeting at OSHA on this topic, and I clearly remember David Michaels say that it was his last day, and good luck getting this standard done. I also remember the tears on the faces of the women who had traveled at their own expense to tell their stories of horrific WPV, hoping that it was a serious effort to prevent WPV, and realizing that yet again, nothing would get done. Lots of people have dropped the ball on this. Who is going to pick it back up?

Good question Donna. You’re right, workplace violence — especially against health care workers — has been a hazard for a long time. I’ve been working on the issue for 35 years, all the way back to my early days with AFSCME. The problem is the the OSHA standard making process is extremely burdensome and time-consuming. Although workplace violence was high on my list of things to address at OSHA, other regulatory priorities — those closer to actually finalizing (like silica, beryllium, etc) — took priority.
Nevertheless, we did make some progress. We updated the 1998 health care guidance document, trained OSHA inspectors, implemented an emphasis program that included workplace violence, issued a compliance directive, significantly increased the number of workplace violence inspections and settlements and — finally — got the issue on the regulatory agenda, where (even in the Trump administration) it seem to be moving slowly forward.
That’s not enough, I admit. But you do what you can.

Thank you Jordan for your efforts on this issue. I also appreciate that many dedicated OSHA folks are also disappointed that this standard is not progressing. But what can we do? Some of the best and brightest minds in labor read your posts. Seriously, lets get something going. I assume that H.R. 5223 will probably not move out of committee, and there will be no Federal OSHA Standard (for many years). State by State legislation can work if there is a regulatory component, but its only touching the surface. Is there any group / entity that is trying to bring together labor, AHA, TJC, Nursing Organizations (like ANA, ENA, AAOHN), AIHA, NIOSH, OSHA, Support groups for victims – like Silent No More, etc., to work on this issue, without waiting for legislation or a standard? I realize this sounds “pie in the sky”, but there is nothing to lose in trying. I’m in (to help deliver Nursing representation) if someone with bona fides can get the rest of the big players at the table. “you may say I’m a dreamer, but I’m not the only one”.

Thanks, Jordan, for addressing this hazard- we need to keep this issue front and center. As you mentioned, it’s only getting worse and will continue to do so. An OSHA regulation is what is needed. Let’s hope we can get something effective accomplished before too many other healthcare workers get hurt.